WONCA Special Interest Group: Quaternary Prevention & Overmedicalization

Quaternary Prevention & Overmedicalization

A new WONCA Special Interest Group on Quaternary Prevention and Overmedicalization was approved by the WONCA Council in October 2016. Membership is open to interested family doctors. 

Introduction: Justification and Importance

“Medicine increasingly focuses on the problems that result from an excess of medical care, in particular overscreening and overdiagnosis. In a new framework or paradigm, based on patient doctor relationships, quaternary prevention (P4) describes the protection of patients from diagnostic tests, interventions and treatments that offer no benefit for overall morbidity or mortality for the individual, and may cause physical or psychological harm. It includes the protection of patients from misled well-meaning doctors and from a system in which the commercial interests of pharmaceutical and diagnostic companies, and governments working in a marketised model of health care, that can distort care, medicalize normal life and waste resources”. Jamoulle M, Mangin D (not published).


The original definition of Quaternary Prevention was formulated in 1986: Action taken to identify patient at risk of overmedicalization, to protect him from new medical invasion, and to suggest to him interventions, which are ethically acceptable.

The concept of quaternary prevention is grounded in the ethical principles of medicine, an epistemological understanding of a paradigm crisis or struggle that is challenging the predominant biological paradigm in health, and the realization of a movement that includes citizens, patients, care providers and public health policies.

Quaternary prevention provides a complex but necessary approach oriented to provide person -focused care; promote equity in healthcare; prevent overdiagnosis, unnecessary interventions, and avoid harm: and so, in few words, to humanize medicine. All the efforts within this global movement combine ethical sustainability with critical thinking, to oppose the vision of health as a commodity.

Understanding of the power of the socio-cultural determinants of health requires family and community medicine to re-think the approach to healthcare and to work in a huge network with all the relevant actors (persons/consumers, community stakeholders, providers, health managers, and politicians). Quaternary prevention applies primarily to the interpersonal level in the patient-doctor encounter. Confronting overdiagnosis and overuse are complementary issues with a different focus.

In the context of this broad approach it is clear that the tasks of quaternary prevention go beyond preventive activity and its conceptual scope can underpin all aspects of everyday medical activity in the face of uncertainty.

Overdiagnosis is understood to occur when an asymptomatic person is identified as having a disease, which would never harm them in their lifetime.

Convenor / Chair

Dr Karin Kopitowski (Argentina)

email convenor

Dr Karin Kopitowski is a family doctor born in 1966 in Buenos Aires, Argentina, where she resides to date. She did her Family Medicine Residency at Hospital Italiano de Buenos Aires.
Her interests mainly focused on people-centred care, evidence-based medicine, and skills to provide high-value care throughout her professional career.

Currently, she is the head of the Family and Community Medicine Service of the Hospital Italiano de Buenos Aires and the Director of the Research Department of the Instituto Universitario Hospital Italiano. She also serves as an undergraduate and graduate teacher in public and private universities.

Dr Kopitowski is President of the Argentine Federation of Family and General Medicine. She considers quaternary prevention and actions to limit the medicalization of people's lives as a crucial element of Family Medicine.

For this reason, she has dedicated her career to teaching these contents in undergraduate and graduate studies. She has also researched the subject, written editorials, and carried out activities in the congresses of these and others specialities.

For Dr  Kopitowski, participation and communications are essential in Family Medicine and her daily interaction with specialists. Therefore, she takes advantage of the resources offered by the mass media to educate the population and future doctors. 

“Many actions have been taken from the perspective of quaternary prevention, but much remains to be done. Among professionals, there is certain illiteracy in these topics, so I consider that the degree constitutes a unique opportunity to educate future doctor.

We must continue researching and documenting this issue as well. And disseminate with the focus on healthcare professionals and the general public.

From my position as chair of this WONCA SIG, I trust that we can build networks so that quaternary prevention becomes a reality and a way of thinking about the practice of family medicine that we experience”

Co-Convenor or other office bearers

Executive Members

Membership Open?

Vision and Mission of WONCA SIG on Quaternary Prevention & Overmedicalization

To create an international network to support ongoing activities and promote dissemination and skills to apply the concepts all over the world.

Objectives of the WONCA SIG on Quaternary Prevention & Overmedicalization

- Facilitate cooperation among societies and professionals in order to promote knowledge exchange and expertise.
- Promote critical attitude and critical thinking about the profound conflicts of interest that undermine medical activities.
- Promote critical literature review networks
- Promote quaternary prevention focus on research questions and projects
- Give support to national societies to include quaternary prevention and overmedicalization in the undergraduate and graduate programs.
- Promote understanding of over medicalisation and the need for quaternary prevention in the global mass media.
- Promote cooperation between existing resources and organizations (Universities facilities, Pharmacovigilance, Cochrane reviews, Journals interest, qualitative research skills, population participation, mass media presence, Choosing Wisely, Preventing Overdiagnosis)
- Organize WONCA activities oriented to disseminate the concept and share experiences.
- Resources would come from WONCA members, grants, awards, web services and create a foundation.

>link to full document


Relevant Resources

Silva AL, Mangin D, Pizzanelli M, Jamoulle M, Wagner HL, Silva DH et al. Manifesto de Curitiba: pela Prevenção Quaternária e por uma Medicinan sem conflitos de interesse. Rev Bras Med Fam Comunidade. 2014;9(33):371-374. Disponível em http://dx.doi.org/10.5712/ rbmfc9(32)1006

SUMEFAC/ Grupo de Trabajo en Prevención Cuaternaria. Propuesta de actividades Seminario Internacional Prevención Cuaternaria. Actividades Preparatorias al 4º Congreso Iberoamericano DE Medicina Familiar y Comunitaria, marzo 2015 [base de datos en Internet]*. Uruguay: SUMEFAC – Pizzanelli M.; Julio 2015, [acceso 21 de julio de 2016]. Disponible en: https://drive.google.com/file/d/0B2tjwHv1enqDcXR1Vkpmb2pFbDA/view?usp=sharing